This is a two-stage study of efficacy, safety, pharmacokinetics, pharmacodynamics, and immunogenicity of various doses of levilimab when administered intravenously and subcutaneously to healthy subjects and subjects with active rheumatoid arthritis resistant to methotrexate monotherapy. Aim of the Stage 1 is to study the tolerability, safety, immunogenicity, and main pharmacokinetic and pharmacodynamic parameters of levilimab after its single subcutaneous or intravenous administration at ascending doses to healthy subjects. Aim of the Stage 2 is to confirm the efficacy and safety of levilimab 648 mg IV Q4W in combination with methotrexate and levilimab 324 mg SC Q2W in combination with methotrexate in subjects with active rheumatoid arthritis, resistant to methotrexate monotherapy.
Stage 1: there are 3 dose levels and 5 cohorts. The subjects will be followed up for up to 71 days after the IP administration. Stage 2: the main period of the study (Weeks 0-24) is blinded; study subjects will receive levilimab with placebo. At Week 24 the study will become open-label and all subjects will continue to receive levilimab. At week 28 patients who achieved the RA remission at week 24 will be switched to maintenance therapy of levilimab and will receive it through Week 52. Subjects who do not achieve remission at Week 24, will continue to receive levilimab from Week 28 to Week 52 inclusive corresponding to their treatment group.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
261
Subcutaneous or intravenous injection of levilimab with placebo.
X7 Clinical Research
Saint Petersburg, Russia
Safety primary endpoint (Stage 1)
To determine the safety profile of levilimab following its single subcutaneous or intravenous administration at ascending doses in healthy subjects.
Time frame: Up to day 71
Low disease activity (Stage 2)
Proportion of subjects with low activity of rheumatoid arthritis (DAS28-ESR \<3.2) at Week 24 of the study in each treatment group.
Time frame: Up to Week 24
RA remission (Stage 2, main period)
Proportion of subjects who achieved RA remission according to DAS28-CRP (\<2.6), DAS28-ESR (\<2.6), CDAI (≤2.8), SDAI (≤3.3), and ACR/EULAR 2011
Time frame: Up to Week 24
RA remission (Stage 2, main period)
Proportion of subjects who achieved RA remission according to DAS28-CRP (\<2.6), DAS28-ESR (\<2.6), CDAI (≤2.8), SDAI (≤3.3), and ACR/EULAR 2011
Time frame: Up to Week 52
PK endpoints (Stage 1)
AUC0-1680
Time frame: Up to Week 52
PK endpoints (Stage 1)
AUC0-1680
Time frame: Up to Week 24
PK endpoints (Stage 1)
AUC0-∞
Time frame: Up to Week 24
PK endpoints (Stage 1)
AUC0-∞
Time frame: Up to Week 52
PK endpoints (Stage 1)
Cmax
Time frame: Up to Week 24
PK endpoints (Stage 1)
Cmax
Time frame: Up to Week 52
PK endpoints (Stage 1)
Cmin
Time frame: Up to Week 24
PK endpoints (Stage 1)
Cmin
Time frame: Up to Week 52
PK endpoints (Stage 1)
Tmax
Time frame: Up to Week 24
PK endpoints (Stage 1)
Tmax
Time frame: Up to Week 52
PK endpoints (Stage 1)
Tmin
Time frame: Up to Week 24
PK endpoints (Stage 1)
Tmin
Time frame: Up to Week 52
PK endpoints (Stage 1)
Vd
Time frame: Up to Week 24
PK endpoints (Stage 1)
Vd
Time frame: Up to Week 52
PK endpoints (Stage 1)
T½
Time frame: Up to Week 24
PK endpoints (Stage 1)
T½
Time frame: Up to Week 52
PK endpoints (Stage 1)
Kel
Time frame: Up to Week 24
PK endpoints (Stage 1)
Kel
Time frame: Up to Week 52
PK endpoints (Stage 1)
CL
Time frame: Up to Week 24
PK endpoints (Stage 1)
CL
Time frame: Up to Week 52
ACR response (Stage 2, main period)
Proportion of subjects who achieved ACR20, ACR50 and ACR70
Time frame: Week 24, 52
Low disease activity (Stage 2, main period)
Proportion of subjects with low rheumatoid arthritis activity according to DAS28-CRP (\<3.2), DAS28-ESR (\<3.2), CDAI (≤10), SDAI (≤11)
Time frame: Week 24, 52
Changes in RA indexes (Stage 2, main period)
Change in DAS28-CRP, DAS28-ESR, CDAI and SDAI from baseline
Time frame: Week 24, 52
Moderate/good response according to the EULAR criteria (Stage 2)
Proportion of subjects with moderate and good response according to the EULAR criteria at Week 24 and 52 compared with baseline values.
Time frame: Week 24, 52
Change in the serum C-reactive protein concentration (Stage 2)
Change in the serum C-reactive protein concentration from baseline
Time frame: Week 24, 52
Change in ESR (Stage 2)
Change in ESR from baseline
Time frame: Week 24, 52
Change in the quality of life measured with SF-36 (Stage 2)
Change in the quality of life according to the SF-36 questionnaire from baseline
Time frame: Week 24, 52
Change in the quality of life measured with the EQ-5D-3L (Stage 2)
Change in the quality of life according to the EQ-5D-3L questionnaire from baseline
Time frame: Week 24, 52
Change in the Functional Assessment of Chronic Illness Therapy - Fatigue (FACIT-F) score (Stage 2)
Change in the fatigue assessments according to the FACIT-F questionnaire from baseline
Time frame: Week 24, 52
Change in functional activity (Stage 2)
Change in the functional activity according to the HAQ-DI questionnaire from baseline
Time frame: Week 24, 52
X-Ray assessment (Stage 2)
Radiographic characterization of the affected joints at Week 24: change in mean modified total Sharp/van der Heijde score (mTSS).
Time frame: Week 24, 52
Key Secondary PK endpoint (Stage 2)
Ctrough geometric mean in each treatment group
Time frame: Week 24
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